C-Section

A cesarean birth (C-section) is when a baby is born by coming through surgical cuts or incisions in the mothers' belly through her skin, fat, muscle and uterus. Sometimes a C-section is necessary because of complications or risks ― if a baby is not in a head-down position or the mother has a serious medical condition, for example. If a C-section is not necessary, a vaginal birth is always preferable.

What is the NTSV (low-risk) C-section measure?

The Nulliparous, Term, Singleton, Vertex (NTSV) C-section measure is the rate at which C-sections occur among first-time moms at low risk of experiencing labor complications. NTSV is the best measure of unnecessary C-sections. This rate identifies the proportion of single live babies in a head-first position born at or beyond 37 weeks of pregnancy to women in their first pregnancy. Unfortunately, nearly half of the hospitals in New York City and Long Island do not publicly report this rate. 

On this site, you will find the NTSV C-section measure for hospitals that report this rate to The Leapfrog Group, a nonprofit watchdog organization that collects, analyzes and disseminates hospital data. You can find out more about The Leapfrog Group here: http://www.leapfroggroup.org/compare-hospitals

What is the Total C-section measure?

Total C-section rates represent the percentage of all live births born via C-section. This includes situations in which a C-section might have been safely avoided as well as instances in which it offered benefits to mother or child. A hospital with a higher Total C-section rate than the average for all hospitals on the site could mean a higher likelihood of having a C-section if you give birth at that hospital. It could also mean the hospital cares for a high number of women with complicated or high-risk births that necessitate C-sections.

What is the difference between the NTSV C-section measure and the Total C-section measure?

The NTSV C-section measure identifies only the proportion of single live babies in a head-first position born at or beyond 37 weeks of pregnancy to women in their first pregnancy that were delivered via C-section. The Total C-section rate identifies the proportion of all live births born via C-section. 

Why does this site include both measures?

The NTSV C-section measure is the best measure for an expectant mother to know and understand because it reflects C-section rates for women considered at low risk for such a procedure. But more than 40% of the hospitals with information on this site do not publicly report this measure. Including the Total C-section rate, therefore, provides information about the overall frequency of C-sections at all hospitals.

What do C-sections mean for me and my baby?

A C-section is major surgery that poses risks such as infection, blood clots, trouble breastfeeding and a longer recovery. Babies born by C-section can have breathing difficulties and are more likely to develop asthma or allergies later in life. For these reasons, reducing the number of C-sections that aren't medically necessary should be a high priority for all hospitals, physicians, other maternity care providers and pregnant women.

Why do hospital C-section measures matter?

C-section rates vary widely from hospital to hospital. Many factors may affect a hospital's rate, such as variations in doctors' training and practice styles, and hospital labor management policies. Some hospitals care for a high number of women with complicated or high-risk births and these hospitals can be expected to have higher C-section rates overall. Many maternity care leaders believe that we can safely bring down C-section rates quite a bit over time.

What can I do with this information?

Knowing a hospital's NTSV C-section or Total C-section rate can help you assess the chances that you may end up giving birth by C-section. The risks of C-sections are clear and giving birth at a hospital with a lower NTSV C-section or Total C-section rate can help reduce the likelihood of having a C-section that is not medically needed. Be sure to discuss with your doctor or midwife whether you can safely avoid a C-section and make sure your care team and hospital clearly understand your birthing plan and preferences.

What does the goal mean?

Healthy People 2020 is a U.S. government agenda for improving the nation’s health, including science-based benchmarks. Healthy People 2020’s  NTSV C-section benchmark target rate is 23.9% https://www.healthypeople.gov/2020/data-search/Search-the-Data#topic-area=3492

This rate has also adopted by The Leapfrog Group  http://www.leapfroggroup.org/ratings-reports/rate-c-sections with the guidance of its Maternity Care Expert Panel http://www.leapfroggroup.org/about/expert-panelists